Optimizing Value and Patient Outcomes Through Comprehensive Medication Management September 18, 2018 www.facebook.com/pcpcc www.twitter.com/pcpcc
Welcome & Announcements • Welcome – Julie Schilz, PCPCC Executive Member Liaison • PCPCC Annual Conference – Key Policies to Elevate Primary Care Washington, DC, November 8, 2018 Registration: www.pcpccevents.com • Members Only Workshop : Investing in Primary Care – Advancing a National Strategy Immediately following the PCPCC annual conference, Executive Members are invited to an exclusive workshop on November 9, 2018 Registration : www.pcpccevents.com For those that missed it, PCPCC released it’s annual Evidence Report in August • Advanced Primary Care: A Key Contributor to Successful ACOs View the report: www.pccc.org/resource/evidence2018 • Interested in PCPCC Executive Membership? Email Allison Gross (agross@pcpcc.org) or visit www.pcpcc.org/executive-membership
Panelists Amanda Brummel, PharmD, BCACP Moderator: Julie Schilz Director, Clinical Ambulatory Pharmacy Services PCPCC Executive Member Liaison Mathematica Policy Research Fairview Pharmacy Services Daniel Rehrauer, PharmD Mark Loafman, MD, MPH Senior Manager, Medication Therapy Chair, Family and Community Medicine Management Program Cook County Health and Hospitals Systems HealthPartners
Comprehensive Medication Management Services (CMM)
Clinical Pharmacy and the Expanded Primary Care Team: The Case for Comprehensive Medication Management • > 50 % patients have > 1 uncontrolled “Rx sensitive” condition • < 50% of Rx are taken as recommended • $1 harm caused by every $1 spent on Rx use • 20% of patients = 80% costs!!! and 5% = 50 • Healthcare workforce struggles to find “Joy and Satisfaction” … and the suffering among patients we know!!! Dr. R.U. Compliant
Primary Care Struggles & Too Often Fails to Halt Disease Progression Urgently Early High Risk Ill with Chronic Chronic Advanced Conditions Disease Disease 20% cause 80% costs!!! and 5% cost 50% … and the suffering among patients we know!!! Healthy Population w/little need for rescue care
The Building Blocks of High Performing Primary Care ABSTRACT: Studied exemplar primary care practices to find the essential elements of high performing care : • Engaged leadership creating a practice wide vision • Data-driven improvement using IT • Empanelment, and team-based care • Patient-team partnership • Population management • Continuity of care • Prompt access to care • Comprehensiveness and care coordination Thomas Bodenheimer, MD, Amireh Ghorob, MPH, Rachel Willard-Grace, MPH, Kevin Grumbach, MD Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 12, NO. 2 ✦ MARCH/APRIL 2014 7 Department of Family and Community Medicine
The Patient Centric, Team-based “Get to Goal” Care Our Patients Need Early Urgently High Risk Ill with Chronic Chronic Advance Disease Disease Disease Comprehensive Medication Management Healthy Population
Our Med Management Paradox: Why we Need CMM!!! Urgently Ill Early High Risk with Chronic Chronic Advance Disease Disease Disease
Pharmacists are key members of the patient care team. 10
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Clinical Value Have pharmacists impacted the clinical outcomes of patients? 12
Helping patients get and stay healthier Patients with diabetes who were optimally managed by CMM pharmacists • Brummel, A. “Optimal Diabetes Care Outcomes Following Face-to-Face Medication Therapy 13 Management Services” Population Health Management: 2012
Clinic a l Outc ome s – Dia be te s Control Baseline (no Baseline 8 years 8 years MTM) (MTM) (no MTM) (MTM) N=370 N=296 LDL controlled 70.2% 61.6% 73.9% 93% A1C controlled 52.9% 72.8% 48% 83.5% BP controlled 53.7% 84.1% 54.9% 84.7% Aspirin Use 85.2% 100% 90.9% 100% Not smoking 86.2% 86.6% 89.5% 92.9% Optimal diabetes control 16.5% 37.5% 16.2% 67.1% *Internal HealthPartners data
Hype rte nsion Intervention BP Usual Care BP Control Control P Value N=228 N=222 6 months 71.8% 45.2% <.001 12 months 71.2% 52.8% .005 18 months 71.8% 57.1% .003 Effect of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Control: A Cluster Randomized Clinical Trial JAMA 2013;310(1):46-56.
CMM services resulted in improvement of medication adherence with statins, ACEI/ARBs, and B-Blockers Medication Adherence Brummel, A, Carlson, A. Comprehensive Medication Management and Medication Adherence for 16 Chronic Conditions. Journal of Managed Care Pharmacy 2016; 22 (1); 56-62.
Helping patients get and stay healthier Transitions of Care and CMM Budlong H., et al., “Impact of Comprehensive Medication Management on Hospital Readmission 17 Rates,” Population Health Management , 2018.
Home Visits 30 Day Hospital Readmissions 18% 16% 16% 14% 12% 10% 8% 6% 6% 4% 2% 0% MTM Visit No Visit
Economic Impact Do CMM pharmacists impact the total cost of care? 19
An average 12- to-1 return on investment in terms of reduced overall healthcare costs. • Isetts et al. “Clinical and Economic Outcomes of Medication Therapy Management Services: 20 The Minnesota Experience” J Am Pharm Assoc . 2008;48(2):203-211)
An employer analysis showed that for each $1 of MTM billed costs an average of $8.98 savings of total health care costs occurred. 21
He a lthPa rtne rs Comme rc ia lly Insure d ROI *Internal HealthPartners health plan data
Dia be te s Pilot Prog ra m 97 fewer hospital admissions = $809,000 savings! 199 fewer Projected Cost Savings Emergency of Room visits = $967,000 $157,500 savings!
Humanistic Outcomes Do patients and providers find value in CMM services? 24
Patient Satisfaction 95% of patients agreed or strongly agreed that their overall health and well-being had improved because of CMM 25
Wha t a re pa tie nts sa ying a bout MT M? Patient Experience Survey Comments “I wish I would have known about this service before. We had a really good talk. I found out a lot. I got all my questions answered and more. I will be telling a lot of people about this. Thanks.” 26
Provider wellness & joy 95% of providers surveyed were confident in the recommendations of the Fairview CMM pharmacist 27
Ca re T e a m Va lue Quote s ‘Someone with her skill level, it’s easy to involve her with the Clinicians complex medication regimens. I know she’s competent and I can trust her.’ ‘We all have a different perspective on the patient’s Care needs. Knowing her eyes Team are on patients’ meds helps elevate the whole practice.’ My patients love [pharmacist name] and repeatedly request her Care by name. She has been a wonderful Managers asset to our clinic and has greatly enhanced the care that I am able to provide to my patients. Clinician/Care Team Interviews and Survey Comments 28
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What does it look like? CMM practitioner takes responsibility for a patient’s drug related needs, and is held accountable for this commitment Focus on a patient’s needs and ensuring responsible medication therapy is provided to achieve their goals. 31
01 Consistent Patient Care Process/Practice Model 02 Understand the role on the team 03 Focus on appropriate Critical populations/hardwire a process for referrals. Components 04 Find a champion/build When relationships Implementing CMM 32
Reproducible Consistent Results Practice Model What do you need to Have Consistent ensure CMM will be measurable Patient Care outcomes successful? Process Support from leadership/ team 33
Wrap Up: Groundwork for Rolling Out a Comprehensive Med Mgmt “Bundle” for Primary Care Staff Roles: Focus on CMM, not just refills and med recon • Patient satisfying, joy in practice and ROI generating, and life saving CMM Medication Reconciliation: Continue v. Optimize v. DEPRESCRIBE • Assess Indication, Effectiveness, Interactions (and real world adherence) Refill Process: Establish the Patients “Pharmacy Home” (Tracking & Formulary) • Sufficient refills until next planned visit: not “bait” for future clinic visits • Last refill = schedule f/u visit, (call pharmacy for refills, call us for appointments) Rollout/Ramp up Comprehensive Medication Management Risk Stratified population of focus, and high impact performance measures Pharmacy Staffing Solutions? Pharmacy Training, Expanded Tech roles, ROI, etc.
Leave in Action • Act to deploy Comprehensive Medication Management in your practice • Our patients need disruptive innovators to Get the Meds Right • Ask not: “What’s the least disruptive way I can stay in compliance” but rather, How can I partner with pharmacists, payers and others to move our practice from churning volume to generating life saving value?
Questions? www.facebook.com/pcpcc www.twitter.com/pcpcc
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